Teledermatology for the diagnosis and management of skin cancer: a systematic review

Finnane, Anna, Dallest, Kathy, Janda, Monika and Soyer, H. Peter (2017) Teledermatology for the diagnosis and management of skin cancer: a systematic review. JAMA Dermatology, 153 3: 319-327. doi:10.1001/jamadermatol.2016.4361


Author Finnane, Anna
Dallest, Kathy
Janda, Monika
Soyer, H. Peter
Title Teledermatology for the diagnosis and management of skin cancer: a systematic review
Journal name JAMA Dermatology   Check publisher's open access policy
ISSN 2168-6068
2168-6084
Publication date 2017-03-01
Year available 2017
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1001/jamadermatol.2016.4361
Open Access Status Not yet assessed
Volume 153
Issue 3
Start page 319
End page 327
Total pages 9
Place of publication Chicago, IL, United States
Publisher American Medical Association
Language eng
Subject 2708 Dermatology
Abstract IMPORTANCE As technology becomes more commonplace in dermatological practice, it is essential to continuously review the accuracy of teledermatology devices and services compared with in-person care. The last systematic review was conducted over 5 years ago. OBJECTIVE To synthesize and assess the quality of the evidence to address 3 research questions: (1) How accurate is teledermatology for skin cancer diagnosis compared with usual care (face-to-face [FTF] diagnosis)? (2) Does teledermatology save clinician and/or patient time, compared with usual care? (3) What are the enablers and barriers to adoption of teledermatology in clinical practice for the diagnosis of skin cancer? EVIDENCE REVIEW The review protocol was registered in the PROSPERO database. Six databases (Cochrane, PubMed, Medline, Science Direct, Embase, andWeb of Science) were searched for studies investigating the diagnostic accuracy and concordance, management accuracy and concordance, measures of time (waiting times, delay to diagnosis), and enablers and barriers to implementation. Potentially eligible articles were screened by 2 reviewers. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was used to evaluate the risk of bias and applicability of individual studies assessing diagnostic accuracy. FINDINGS Twenty-one studies were reviewed. The diagnostic accuracy (defined as agreement with histopathology for excised lesions or clinical diagnosis for nonexcised lesions) of FTF dermatology consultation remains higher (67%-85%agreement with reference standard, Cohen κ, 0.90) when compared with teledermatology (51%-85%agreement with reference standard, κ, 0.41-0.63), for the diagnosis of skin cancer. However, some studies do report high accuracy of teledermatology diagnoses. Most studies of diagnostic accuracy and concordance had significant methodological limitations. Studies of health service outcomes found teledermatology reduced waiting times and could result in earlier assessment and treatment. Patients reported high satisfaction and were willing to pay out of pocket for access to such services. CONCLUSIONS AND RELEVANCE Robust implementation studies of teledermatology are needed, paying careful attention to reducing risk of bias when assessing diagnostic accuracy. Teledermatology services consistently reduced waiting times to assessment and diagnosis, and patient satisfaction was high.
Formatted abstract
Importance: As technology becomes more commonplace in dermatological practice, it is essential to continuously review the accuracy of teledermatology devices and services compared with in-person care. The last systematic review was conducted over 5 years ago.

Objective: To synthesize and assess the quality of the evidence to address 3 research questions: (1) How accurate is teledermatology for skin cancer diagnosis compared with usual care (face-to-face [FTF] diagnosis)? (2) Does teledermatology save clinician and/or patient time, compared with usual care? (3) What are the enablers and barriers to adoption of teledermatology in clinical practice for the diagnosis of skin cancer?

Evidence Review: The review protocol was registered in the PROSPERO database. Six databases (Cochrane, PubMed, Medline, Science Direct, Embase, andWeb of Science) were searched for studies investigating the diagnostic accuracy and concordance, management accuracy and concordance, measures of time (waiting times, delay to diagnosis), and enablers and barriers to implementation. Potentially eligible articles were screened by 2 reviewers. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was used to evaluate the risk of bias and applicability of individual studies assessing diagnostic accuracy.

Findings: Twenty-one studies were reviewed. The diagnostic accuracy (defined as agreement with histopathology for excised lesions or clinical diagnosis for nonexcised lesions) of FTF dermatology consultation remains higher (67%-85%agreement with reference standard, Cohen κ, 0.90) when compared with teledermatology (51%-85%agreement with reference standard, κ, 0.41-0.63), for the diagnosis of skin cancer. However, some studies do report high accuracy of teledermatology diagnoses. Most studies of diagnostic accuracy and concordance had significant methodological limitations. Studies of health service outcomes found teledermatology reduced waiting times and could result in earlier assessment and treatment. Patients reported high satisfaction and were willing to pay out of pocket for access to such services.

Conclusions and Relevance: Robust implementation studies of teledermatology are needed, paying careful attention to reducing risk of bias when assessing diagnostic accuracy. Teledermatology services consistently reduced waiting times to assessment and diagnosis, and patient satisfaction was high.
Keyword Mobile Teledermoscopy
Forward Teledermatology
Self-Examination
Primary-Care
Accuracy
Melanoma
Neoplasms
Service
Triage
Technologies
Q-Index Code C1
Q-Index Status Provisional Code
Grant ID APP1061183
APP1099021
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: HERDC Pre-Audit
Institute for Molecular Bioscience - Publications
UQ Diamantina Institute Publications
Admin Only - UQ Diamantina Institute
 
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